Clinical Nurse Auditor, HEDIS •Remote •
The on-call HEDIS Clinical Audit Coordinator is responsible for conducting clinical quality audits for the Quality Department. The auditor identifies and coordinates clinical audits to determine potential areas for quality improvement within the PHP network. The audit coordinator collects data by way of chart extraction, using objective specifications for the Healthcare Effectiveness and Data Information Set (HEDIS) program. Audits include review of outpatient medical records, hospital records, clinical lab and pharmacy records. The coordinator is responsible for collecting data based on standardized methodologies and organizes the data to identify and address opportunities for improvement. This position is an on-call position, and much of the work is seasonal. Individuals in this role will be able to perform chart audits electronically or on site in physician practices during the audit season, which runs approximately February through mid-May. The RN auditor will successfully complete HEDIS training prior to performing chart abstractions. Direction regarding charts require auditing will be provided by staff Clinical QI Coordinator RNs. The auditor maintains all collected records in a confidential manner and performs all duties in a manner which promotes team concept and reflects the Sisters of Providence mission and philosophy. The RN auditor will communicate in a collaborative manner with clinic and other staff with whom they interact, in a manner that represents Sisters of Providence. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Health Plan Partners and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Required Qualifications : • Degree in Nursing • Oregon Registered Nurse License • 5+ years clinical experience (Nursing) Preferred Qualifications : • Bachelor's Degree in Nursing • Dual RN License : Oregon and Washington • 1 year Quality management / quality improvement / utilization review auditing experience, including experience in auditing within electronic health records. • Experience with health plans, project management, program evaluation, team facilitation, data analysis, and / or case review. Why Join Providence Health Plan? Our are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our of caring for everyone, especially the most vulnerable in our communities. Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons. Apply tot his job